|
HC PURAPLY AM (1.6 SQ CM DISC) PER SQ CM
|
Facility
|
OP
|
$752.14
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$676.93 |
| Rate for Payer: Aetna American Axle |
$488.89
|
| Rate for Payer: Aetna Commercial |
$639.32
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$313.49
|
| Rate for Payer: BCN Commercial |
$313.49
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$601.71
|
| Rate for Payer: Cash Price |
$601.71
|
| Rate for Payer: Cofinity Advantage |
$526.50
|
| Rate for Payer: Cofinity Commercial |
$646.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$601.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$676.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$526.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$564.11
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$639.32
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.11
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$639.32
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$473.85
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$278.29
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$564.11
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
OP
|
$522.31
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$470.08 |
| Rate for Payer: Aetna American Axle |
$339.50
|
| Rate for Payer: Aetna Commercial |
$443.96
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$313.49
|
| Rate for Payer: BCN Commercial |
$313.49
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$417.85
|
| Rate for Payer: Cash Price |
$417.85
|
| Rate for Payer: Cofinity Advantage |
$365.62
|
| Rate for Payer: Cofinity Commercial |
$449.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$470.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$365.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.73
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.96
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.73
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$443.96
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$329.06
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$193.25
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.73
|
|
|
HC PURAPLY AM 2X2 PER SQ CM
|
Facility
|
IP
|
$522.31
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$229.82 |
| Max. Negotiated Rate |
$470.08 |
| Rate for Payer: Aetna American Axle |
$339.50
|
| Rate for Payer: Aetna Commercial |
$443.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.50
|
| Rate for Payer: Cash Price |
$417.85
|
| Rate for Payer: Cofinity Advantage |
$365.62
|
| Rate for Payer: Cofinity Commercial |
$449.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.85
|
| Rate for Payer: Healthscope Commercial |
$470.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$365.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.73
|
| Rate for Payer: PHP Commercial |
$443.96
|
| Rate for Payer: Priority Health SBD |
$329.06
|
| Rate for Payer: UMR Bronson Commercial |
$229.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.73
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
IP
|
$330.80
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.55 |
| Max. Negotiated Rate |
$297.72 |
| Rate for Payer: Aetna American Axle |
$215.02
|
| Rate for Payer: Aetna Commercial |
$281.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.02
|
| Rate for Payer: Cash Price |
$264.64
|
| Rate for Payer: Cofinity Advantage |
$231.56
|
| Rate for Payer: Cofinity Commercial |
$284.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.64
|
| Rate for Payer: Healthscope Commercial |
$297.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.10
|
| Rate for Payer: PHP Commercial |
$281.18
|
| Rate for Payer: Priority Health SBD |
$208.40
|
| Rate for Payer: UMR Bronson Commercial |
$145.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.10
|
|
|
HC PURAPLY AM 2X4 PER SQ CM
|
Facility
|
OP
|
$330.80
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$215.02
|
| Rate for Payer: Aetna Commercial |
$281.18
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$313.49
|
| Rate for Payer: BCN Commercial |
$313.49
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$264.64
|
| Rate for Payer: Cash Price |
$264.64
|
| Rate for Payer: Cofinity Advantage |
$231.56
|
| Rate for Payer: Cofinity Commercial |
$284.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$297.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.10
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.18
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.10
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$281.18
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$208.40
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$122.40
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.10
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
OP
|
$276.36
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$179.63
|
| Rate for Payer: Aetna Commercial |
$234.91
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$313.49
|
| Rate for Payer: BCN Commercial |
$313.49
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: Cofinity Advantage |
$193.45
|
| Rate for Payer: Cofinity Commercial |
$237.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$248.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.27
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.91
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.27
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$234.91
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$174.11
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$102.25
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.27
|
|
|
HC PURAPLY AM 3X4 PER SQ CM
|
Facility
|
IP
|
$276.36
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$248.72 |
| Rate for Payer: Aetna American Axle |
$179.63
|
| Rate for Payer: Aetna Commercial |
$234.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.63
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: Cofinity Advantage |
$193.45
|
| Rate for Payer: Cofinity Commercial |
$237.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.09
|
| Rate for Payer: Healthscope Commercial |
$248.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.27
|
| Rate for Payer: PHP Commercial |
$234.91
|
| Rate for Payer: Priority Health SBD |
$174.11
|
| Rate for Payer: UMR Bronson Commercial |
$121.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.27
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$291.83
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.41 |
| Max. Negotiated Rate |
$262.65 |
| Rate for Payer: Aetna American Axle |
$189.69
|
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.69
|
| Rate for Payer: Cash Price |
$233.46
|
| Rate for Payer: Cofinity Advantage |
$204.28
|
| Rate for Payer: Cofinity Commercial |
$250.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.46
|
| Rate for Payer: Healthscope Commercial |
$262.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.87
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: Priority Health SBD |
$183.85
|
| Rate for Payer: UMR Bronson Commercial |
$128.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.87
|
|
|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$291.83
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$189.69
|
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$313.49
|
| Rate for Payer: BCN Commercial |
$313.49
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$233.46
|
| Rate for Payer: Cash Price |
$233.46
|
| Rate for Payer: Cofinity Advantage |
$204.28
|
| Rate for Payer: Cofinity Commercial |
$250.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$262.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.87
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.87
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$183.85
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$107.98
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.87
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
OP
|
$229.22
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$148.99
|
| Rate for Payer: Aetna Commercial |
$194.84
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$313.49
|
| Rate for Payer: BCN Commercial |
$313.49
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cofinity Advantage |
$160.45
|
| Rate for Payer: Cofinity Commercial |
$197.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$206.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.91
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.84
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.91
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$194.84
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$144.41
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$84.81
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.91
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
IP
|
$229.22
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.86 |
| Max. Negotiated Rate |
$206.30 |
| Rate for Payer: Aetna American Axle |
$148.99
|
| Rate for Payer: Aetna Commercial |
$194.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.99
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cofinity Advantage |
$160.45
|
| Rate for Payer: Cofinity Commercial |
$197.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.38
|
| Rate for Payer: Healthscope Commercial |
$206.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.91
|
| Rate for Payer: PHP Commercial |
$194.84
|
| Rate for Payer: Priority Health SBD |
$144.41
|
| Rate for Payer: UMR Bronson Commercial |
$100.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.91
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$229.22
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.86 |
| Max. Negotiated Rate |
$206.30 |
| Rate for Payer: Aetna American Axle |
$148.99
|
| Rate for Payer: Aetna Commercial |
$194.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.99
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cofinity Advantage |
$160.45
|
| Rate for Payer: Cofinity Commercial |
$197.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.38
|
| Rate for Payer: Healthscope Commercial |
$206.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.91
|
| Rate for Payer: PHP Commercial |
$194.84
|
| Rate for Payer: Priority Health SBD |
$144.41
|
| Rate for Payer: UMR Bronson Commercial |
$100.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.91
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$229.22
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$148.99
|
| Rate for Payer: Aetna Commercial |
$194.84
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$313.49
|
| Rate for Payer: BCN Commercial |
$313.49
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cofinity Advantage |
$160.45
|
| Rate for Payer: Cofinity Commercial |
$197.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$206.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.91
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.84
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.91
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$194.84
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$144.41
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$84.81
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.91
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
IP
|
$158.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.84 |
| Max. Negotiated Rate |
$142.86 |
| Rate for Payer: Aetna American Axle |
$103.17
|
| Rate for Payer: Aetna Commercial |
$134.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.17
|
| Rate for Payer: Cash Price |
$126.98
|
| Rate for Payer: Cofinity Advantage |
$111.11
|
| Rate for Payer: Cofinity Commercial |
$136.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.98
|
| Rate for Payer: Healthscope Commercial |
$142.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.05
|
| Rate for Payer: PHP Commercial |
$134.92
|
| Rate for Payer: Priority Health SBD |
$100.00
|
| Rate for Payer: UMR Bronson Commercial |
$69.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.05
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
OP
|
$158.73
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.73 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$103.17
|
| Rate for Payer: Aetna Commercial |
$134.92
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$313.49
|
| Rate for Payer: BCN Commercial |
$313.49
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$126.98
|
| Rate for Payer: Cash Price |
$126.98
|
| Rate for Payer: Cofinity Advantage |
$111.11
|
| Rate for Payer: Cofinity Commercial |
$136.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$142.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.05
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.92
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.05
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$134.92
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$100.00
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$58.73
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.05
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
OP
|
$208.15
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$135.30
|
| Rate for Payer: Aetna Commercial |
$176.93
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$313.49
|
| Rate for Payer: BCN Commercial |
$313.49
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$166.52
|
| Rate for Payer: Cash Price |
$166.52
|
| Rate for Payer: Cofinity Advantage |
$145.71
|
| Rate for Payer: Cofinity Commercial |
$179.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$187.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.11
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.93
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.11
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$176.93
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$131.13
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$77.02
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.11
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
IP
|
$208.15
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$187.34 |
| Rate for Payer: Aetna American Axle |
$135.30
|
| Rate for Payer: Aetna Commercial |
$176.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.30
|
| Rate for Payer: Cash Price |
$166.52
|
| Rate for Payer: Cofinity Advantage |
$145.71
|
| Rate for Payer: Cofinity Commercial |
$179.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.52
|
| Rate for Payer: Healthscope Commercial |
$187.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.11
|
| Rate for Payer: PHP Commercial |
$176.93
|
| Rate for Payer: Priority Health SBD |
$131.13
|
| Rate for Payer: UMR Bronson Commercial |
$91.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.11
|
|
|
HC PURAPLY XT PER SQ CM
|
Facility
|
OP
|
$138.72
|
|
|
Service Code
|
HCPCS Q4197
|
| Hospital Charge Code |
63600245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.33 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna American Axle |
$90.17
|
| Rate for Payer: Aetna Commercial |
$117.91
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$110.98
|
| Rate for Payer: Cash Price |
$110.98
|
| Rate for Payer: Cofinity Advantage |
$97.10
|
| Rate for Payer: Cofinity Commercial |
$119.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$124.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.04
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.91
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.04
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$117.91
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$87.39
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: UMR Bronson Commercial |
$51.33
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.04
|
|
|
HC PURAPLY XT PER SQ CM
|
Facility
|
IP
|
$138.72
|
|
|
Service Code
|
HCPCS Q4197
|
| Hospital Charge Code |
63600245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Aetna American Axle |
$90.17
|
| Rate for Payer: Aetna Commercial |
$117.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.17
|
| Rate for Payer: Cash Price |
$110.98
|
| Rate for Payer: Cofinity Advantage |
$97.10
|
| Rate for Payer: Cofinity Commercial |
$119.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.98
|
| Rate for Payer: Healthscope Commercial |
$124.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.04
|
| Rate for Payer: PHP Commercial |
$117.91
|
| Rate for Payer: Priority Health SBD |
$87.39
|
| Rate for Payer: UMR Bronson Commercial |
$61.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.04
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
IP
|
$169.49
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$74.58 |
| Max. Negotiated Rate |
$152.54 |
| Rate for Payer: Aetna American Axle |
$110.17
|
| Rate for Payer: Aetna Commercial |
$144.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.17
|
| Rate for Payer: Cash Price |
$135.59
|
| Rate for Payer: Cofinity Advantage |
$118.64
|
| Rate for Payer: Cofinity Commercial |
$145.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.59
|
| Rate for Payer: Healthscope Commercial |
$152.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.12
|
| Rate for Payer: PHP Commercial |
$144.07
|
| Rate for Payer: Priority Health SBD |
$106.78
|
| Rate for Payer: UMR Bronson Commercial |
$74.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.12
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
OP
|
$169.49
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$62.71 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna American Axle |
$110.17
|
| Rate for Payer: Aetna Commercial |
$144.07
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$167.66
|
| Rate for Payer: BCN Commercial |
$167.66
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$135.59
|
| Rate for Payer: Cash Price |
$135.59
|
| Rate for Payer: Cofinity Advantage |
$118.64
|
| Rate for Payer: Cofinity Commercial |
$145.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$152.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.12
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.07
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.12
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$144.07
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$106.78
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.17
|
| Rate for Payer: UHC Core |
$88.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$66.61
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: UMR Bronson Commercial |
$62.71
|
| Rate for Payer: VA VA |
$132.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.12
|
|
|
HC PV JAK2V617F
|
Facility
|
IP
|
$336.10
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$147.88 |
| Max. Negotiated Rate |
$302.49 |
| Rate for Payer: Aetna American Axle |
$218.47
|
| Rate for Payer: Aetna Commercial |
$285.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.47
|
| Rate for Payer: Cash Price |
$268.88
|
| Rate for Payer: Cofinity Advantage |
$235.27
|
| Rate for Payer: Cofinity Commercial |
$289.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.88
|
| Rate for Payer: Healthscope Commercial |
$302.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.07
|
| Rate for Payer: PHP Commercial |
$285.69
|
| Rate for Payer: Priority Health SBD |
$211.74
|
| Rate for Payer: UMR Bronson Commercial |
$147.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.07
|
|
|
HC PV JAK2V617F
|
Facility
|
OP
|
$336.10
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$302.49 |
| Rate for Payer: Aetna American Axle |
$218.47
|
| Rate for Payer: Aetna Commercial |
$285.69
|
| Rate for Payer: Aetna Medicare |
$95.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.58
|
| Rate for Payer: BCBS Complete |
$50.34
|
| Rate for Payer: BCBS MAPPO |
$91.66
|
| Rate for Payer: BCBS Trust/PPO |
$105.96
|
| Rate for Payer: BCN Commercial |
$105.96
|
| Rate for Payer: BCN Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$268.88
|
| Rate for Payer: Cash Price |
$268.88
|
| Rate for Payer: Cofinity Advantage |
$235.27
|
| Rate for Payer: Cofinity Commercial |
$289.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$302.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.07
|
| Rate for Payer: Mclaren Medicaid |
$91.66
|
| Rate for Payer: Mclaren Medicare |
$91.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.24
|
| Rate for Payer: Meridian Medicaid |
$96.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.69
|
| Rate for Payer: Nomi Health Commercial |
$274.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.07
|
| Rate for Payer: PACE Medicare |
$87.08
|
| Rate for Payer: PACE SWMI |
$91.66
|
| Rate for Payer: PHP Commercial |
$285.69
|
| Rate for Payer: PHP Medicare Advantage |
$91.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$91.66
|
| Rate for Payer: Priority Health Medicare |
$91.66
|
| Rate for Payer: Priority Health SBD |
$211.74
|
| Rate for Payer: Priority Health Tiered Network |
$73.33
|
| Rate for Payer: Railroad Medicare Medicare |
$91.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.49
|
| Rate for Payer: UHC Core |
$137.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$91.66
|
| Rate for Payer: UHC Exchange |
$137.49
|
| Rate for Payer: UHC Medicaid |
$47.94
|
| Rate for Payer: UHCCP Medicaid |
$47.94
|
| Rate for Payer: UMR Bronson Commercial |
$124.36
|
| Rate for Payer: VA VA |
$91.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.07
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
IP
|
$96.76
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.57 |
| Max. Negotiated Rate |
$87.08 |
| Rate for Payer: Aetna American Axle |
$62.89
|
| Rate for Payer: Aetna Commercial |
$82.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.89
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cofinity Advantage |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$83.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.41
|
| Rate for Payer: Healthscope Commercial |
$87.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.57
|
| Rate for Payer: PHP Commercial |
$82.25
|
| Rate for Payer: Priority Health SBD |
$60.96
|
| Rate for Payer: UMR Bronson Commercial |
$42.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.57
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
OP
|
$96.76
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$87.08 |
| Rate for Payer: Aetna American Axle |
$62.89
|
| Rate for Payer: Aetna Commercial |
$82.25
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.80
|
| Rate for Payer: BCBS Complete |
$5.18
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$10.91
|
| Rate for Payer: BCN Commercial |
$10.91
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cofinity Advantage |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$83.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$87.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.57
|
| Rate for Payer: Mclaren Medicaid |
$9.44
|
| Rate for Payer: Mclaren Medicare |
$9.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: Meridian Medicaid |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.25
|
| Rate for Payer: Nomi Health Commercial |
$14.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.57
|
| Rate for Payer: PACE Medicare |
$8.97
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$82.25
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.44
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health SBD |
$60.96
|
| Rate for Payer: Priority Health Tiered Network |
$7.55
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.16
|
| Rate for Payer: UHC Core |
$14.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.44
|
| Rate for Payer: UHC Exchange |
$14.16
|
| Rate for Payer: UHC Medicaid |
$4.94
|
| Rate for Payer: UHCCP Medicaid |
$4.94
|
| Rate for Payer: UMR Bronson Commercial |
$35.80
|
| Rate for Payer: VA VA |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.57
|
|
